Immediate Repair of an Incompletely Transected Obturator Nerve During Robotic-assisted Pelvic Lymphadenectomy

Göçmen, Ahmet; Şanlıkan, Fatih

doi:10.1016/j.jmig.2014.08.783

Cited by 14 publications

(18 citation statements)

References 6 publications

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“…A recent case also report a similar situation whereby an immediate repair of an incompletely transected obturator nerve resulted in good recovery. [8] However in this case, it was during a robotic assisted pelvic lymphadenectomy for a patient with endometrial cancer.…”

Section: Discussionmentioning

confidence: 94%

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Near Total Transection of the Obturator Nerve and Primary Repair during Laparoscopic Radical Hysterectomy for Cervical Cancer

Lim¹

2017

AJMCR

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Background: Obturator nerve injury is a rare complication and it may occur during pelvic cancer surgery especially during pelvic lymphadenectomy. The injury may cause paraesthesia, sensory loss or pain in the medial thigh which may extend down to the knee. It can also cause weakness in adduction with gait disturbance, medial thigh wasting and possible medico-legal consequences. Case Report: The patient is a 57 year old lady who was found to have an early cervical cancer. MRI abdomen and pelvis was negative for regional lymphadenopathy or distant metastases hence clinically she had a Stage IB1 SCC of cervix. She underwent a Total Laparoscopic Wertheim's Radical Hysterectomy BSO Bilateral Pelvic Lymphadenectomy in February 2015. During the pelvic lymphadenectomy, the left obturator nerve was inadvertently damaged and partially transected by the Harmonic scalpel. The nerve was reconstituted by interrupted 5-O vicryl suture to the epineural layer of the nerve. Post operatively, the patient experienced weakness of the adductor muscles (3/5) but negligible sensory loss. Four months after intensive physiotherapy, the motor deficit was markedly reduced and her gait was normal. There was no sensory loss. Final histology revealed that the surgical margins was clear and 0/41 pelvic lymph nodes were negative. Hence she did not need any adjuvant therapy. Conclusion: Obturator nerve injury is a rare complication with a significant clinical impact if unrecognised. In uncomplicated cases, laparoscopic route of repair is feasible and safe and an immediate repair of the nerve is preferable.

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Section: Discussionmentioning

confidence: 94%

“…[4,5] The microsurgical repair can be achieved usually via laparotomy but there are recent reports of laparoscopic or robotic primary repair with good outcomes. [1,6,7,8] The advantage for laparoscopic repair is the magnification which allows for precise repair, provided the attending surgeon can perform laparoscopic suturing.…”

Section: Discussionmentioning

confidence: 99%

Near Total Transection of the Obturator Nerve and Primary Repair during Laparoscopic Radical Hysterectomy for Cervical Cancer

Lim¹

2017

AJMCR

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“…However, these radical surgeries can also lead to certain complications. Prolonged surgical duration and the associated vascular and nerve injuries can significantly increase the morbidity risk of patients [3].…”

Section: Introductionmentioning

confidence: 99%

Comparison of the harmonic scalpel with scissors in women who experience obturator nerve injury during lymph node dissection for gynaecological malignancies

et al. 2019

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Objectives: Lymphadenectomy is crucial for accurate staging in most gynecological malignancies. Serious complications can occur during the surgery. The present study aimed to present the early and late findings associated with obturator nerve injury, which is rarely observed during lymphadenectomy but can result in serious sequela if not noticed. Material and methods: The files of the patients who underwent lymphadenectomy at our clinic between 2012 and 2018 were examined. Patients with obturator nerve incisions were identified retrospectively. Results: In total, 287 women patients underwent lymphadenectomy at our clinic between 2012 and 2018. Examination of surgical notes revealed that nine patients underwent obturator nerve incisions using a scissor or a harmonic scalpel (energy-activated ultrasonic scissors). With respect to management of obturator nerve damage, no significant difference was found between the use of a harmonic scalpel and scissors (p < 1.000) and the trendelenburg and lithotomy positions (p < 0.167). In addition, no significant difference was found between laparoscopy and laparotomy in terms of surgical type (p < 0.167). At 6 months post-operatively, sensory-motor examinations and EMG findings of the patients were completely normal. Conclusions: Surgeries performed for gynaecological malignancies have high mortality and morbidity rates. Moreover, in the event of a complication such as nerve damage during laparoscopy, successful management of the complication before the patient undergoes laparotomy allows the patient to continue benefitting from the advantages of the laparoscopy. The results of our study show that these high-risk surgeries should be performed in advanced and well-equipped medical centres by teams experienced in gynaecological oncology.

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“…Song et al [3] reported the successful laparoscopic repair of an obturator nerve injury caused by an electrosurgical instrument during laparoscopic pelvic lymphadenectomy in a patient aged 44 years with cervical cancer. Additionally, Göçmen et al [4] repaired an incompletely transected obturator nerve during pelvic lymphadenectomy in a woman aged 62 years with endometrial adenocarcinoma. Complete resolution of symptoms within 1 year after injury was noted in both reports [3,4].…”

mentioning

confidence: 99%

“…Additionally, Göçmen et al [4] repaired an incompletely transected obturator nerve during pelvic lymphadenectomy in a woman aged 62 years with endometrial adenocarcinoma. Complete resolution of symptoms within 1 year after injury was noted in both reports [3,4].…”

mentioning

confidence: 99%

Laparoscopic repair of obturator nerve transection during pelvic lymphadenectomy

Zhang

Jiang

et al. 2015

Intl J Gynecology & Obste

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Immediate Repair of an Incompletely Transected Obturator Nerve During Robotic-assisted Pelvic Lymphadenectomy

Cited by 14 publications

References 6 publications

Near Total Transection of the Obturator Nerve and Primary Repair during Laparoscopic Radical Hysterectomy for Cervical Cancer

Near Total Transection of the Obturator Nerve and Primary Repair during Laparoscopic Radical Hysterectomy for Cervical Cancer

Comparison of the harmonic scalpel with scissors in women who experience obturator nerve injury during lymph node dissection for gynaecological malignancies

Laparoscopic repair of obturator nerve transection during pelvic lymphadenectomy

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